Provider Demographics
NPI:1841721131
Name:HOSPICE FOR UTAH LLC
Entity type:Organization
Organization Name:HOSPICE FOR UTAH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHATCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-560-2761
Mailing Address - Street 1:152 W BURTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2651
Mailing Address - Country:US
Mailing Address - Phone:801-560-8179
Mailing Address - Fax:801-576-1472
Practice Address - Street 1:152 W BURTON AVE STE F
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-2651
Practice Address - Country:US
Practice Address - Phone:801-575-1455
Practice Address - Fax:801-576-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
UT2015-HOSPICE-897251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
461516Medicare UPIN